bubble_chart Content

Hemorrhoids are an extremely common anorectal disease. The local cause is the vascular congestion, swelling, or prolapse of the venous plexuses around the anus due to prolonged pressure. Common symptoms include bleeding during defecation, anal swelling and pain, prolapse, itching, and a sensation of a foreign body. In severe cases, prolapsed hemorrhoids may become unable to be reduced, leading to incarceration and causing intense pain. Sometimes, this condition is easily mistaken for an anal fissure or colorectal tumor.

• Globally, over 50% of adults will experience symptomatic hemorrhoids at least once in their lifetime, with prevalence increasing with age. Their occurrence is closely related to modern lifestyle habits, especially prolonged sitting, prolonged standing, and a low-fiber diet.
• The proportion of women developing hemorrhoids increases significantly during pregnancy and childbirth due to increased abdominal pressure.
• They are most common in adults aged 45 to 65. However, with the prevalence of refined diets and sedentary lifestyles, the incidence rate among younger populations is also increasing. According to relevant statistics, the prevalence of hemorrhoids in Taiwan may be as high as 30% to 40%, making it an extremely common condition in outpatient clinics.

The severity of symptoms is related to the grade of hemorrhoids (e.g., first to fourth degree), but is also closely linked to individual constitution and lifestyle habits.

Hemorrhoids are usually not life-threatening, but they seriously affect quality of life, causing discomfort when sitting or lying down, and affecting defecation smoothness.

Modern Medical Findings

Hemorrhoids are primarily caused by the relaxation of the supporting connective tissue of the anal cushions (vascular-rich soft tissue), leading to obstructed venous return, congestion of the vascular plexuses, and prolapse. They can also be considered a type of varicose vein occurring in the anus. Clinically, they are classified based on location into "Internal Hemorrhoids" and "External Hemorrhoids":

• Internal Hemorrhoids occur above the dentate line and are innervated by visceral nerves, making them relatively insensitive to pain. Early symptoms are mostly painless bleeding and prolapse of hemorrhoidal masses.
• External Hemorrhoids occur below the dentate line and are innervated by somatic nerves, making them sensitive to pain. Symptoms mainly include perianal swelling, sensation of a foreign body, itching, and pain.

If internal and external hemorrhoids coexist and are connected, they are called Mixed Hemorrhoids.

Common pathogenic factors are as follows:

• Poor Bowel Habits: Chronic constipation or diarrhea, spending too long on the toilet (e.g., using a phone), excessive straining during defecation, all persistently increase anal pressure.
• Dietary Factors: Low-fiber diet, insufficient water intake, leading to hard, dry stools; fondness for spicy, irritating foods, and excessive alcohol consumption, which may exacerbate local congestion.
• Lifestyle: Prolonged sitting, prolonged standing, lack of exercise, affecting pelvic blood circulation and leading to venous stasis.
• Increased Abdominal Pressure: Obesity, pregnancy, abdominal tumors, chronic coughing, or heavy lifting, which increase pressure on the perianal veins.
• Genetic Constitution: Higher risk for individuals with a family history of weak venous valve function or tendency for loose connective tissue.
• Aging: Tissue aging and decreased support strength make anal cushions prone to prolapse.
• Other Diseases: Such as liver cirrhosis leading to portal hypertension, which can also induce or aggravate hemorrhoids.

Modern Medical Treatment

For mild to moderate hemorrhoids, the following measures are usually effective:

• Improving Lifestyle Habits: Avoid prolonged sitting and standing, get up and move regularly to promote pelvic blood circulation.
• Dietary Adjustments: Increase dietary fiber and water intake to soften stools and facilitate easier passage.
• Warm Sitz Baths: Soak the hips in warm water several times a day to promote local blood circulation, relax the sphincter, and relieve pain.
• Regular Exercise: Promotes intestinal peristalsis, improves constipation, and strengthens pelvic muscles.

The following auxiliary medications can alleviate symptoms:

• Topical Ointments and Suppositories: Usually contain local anesthetics, steroids, or vasoconstrictors, providing temporary relief from pain, itching, and swelling.
• Oral Painkillers: Such as non-steroidal anti-inflammatory drugs (NSAIDs), can reduce inflammation and pain.
• Oral Venotonic Agents: Can improve venous tone and reduce congestion, but effectiveness varies from person to person.

These medications primarily address the symptoms. If lifestyle habits remain unchanged after stopping medication, recurrence is common.

If the above methods are ineffective, or for more severe hemorrhoids, the following procedures are used:

• Rubber Band Ligation: Suitable for internal hemorrhoids; a rubber band is tied around the base of the hemorrhoid to cut off its blood supply, causing it to necrose and fall off.
• Sclerotherapy Injection: A sclerosing agent is injected around the hemorrhoid to cause fibrosis and shrinkage.
• Hemorrhoidectomy: Surgical removal, typically for severe third or fourth-degree hemorrhoids or external hemorrhoids.
• Stapled Hemorrhoidopexy: Uses a special stapler to remove and simultaneously staple the mucosa, resulting in faster recovery.

The Systemic View of Traditional Chinese Medicine (TCM)

In ancient TCM, hemorrhoids were categorized under terms like "Zhi," "Pin Zhi," "Mu Zhi," etc., and their occurrence was believed to be closely related to systemic imbalances of Qi and Blood, and dysfunction of the Zang-Fu organs.

TCM considers the key to this disease to be "Imbalance of Qi and Blood, Stasis and Obstruction in the Channels." The Large Intestine governs transportation, and the anus is the "Po Men" (Gate of Vitality), whose function is related to the ascending and descending of the body's Qi dynamics. If factors such as dietary irregularities, overexertion, or emotional imbalances lead to pathogenic factors like Wind, Dampness, Heat, and Dryness descending to the Large Intestine, causing Qi and Blood stasis in the anus, the sinews and vessels become slack and form hemorrhoids. Clinically, TCM formulates treatment plans by identifying the corresponding "Pattern" (Zheng), which is an analysis of the systemic pathological model of the disease. Here are several common patterns:

• Wind-Fire and Dryness Binding: Manifested as prolapse during defecation, dripping blood or profuse bleeding, dry and constipated stools passed every few days, resembling sheep droppings, difficult expulsion, accompanied by dry mouth and tongue, restlessness, dizziness, abdominal distension, and scanty dark urine. Often caused by Wind-Fire-Dryness-Heat pathogens accumulating in the rectum and anus. Bleeding is relatively heavy, often dripping or spurting, with swelling, heat, and pain. Treatment should expel Wind, drain Fire, moisten Dryness, and cool Blood.
• Damp-Heat Pouring Downward: Symptoms include anal swelling, burning pain, bleeding, and prolapsed hemorrhoids. Patients often usually consume spicy, rich foods. Treatment focuses on clearing Heat, draining Dampness, activating Blood, and reducing swelling.
• Qi Stagnation and Blood Stasis: Symptoms include prolapsed anal masses, bearing-down sensation, distending pain, even incarceration, with a purplish-dark surface. Mostly caused by obstructed Qi and Blood flow leading to Blood stasis. Treatment focuses on moving Qi, activating Blood, transforming stasis, and relieving pain.
• Spleen Qi Deficiency and Sinking: Symptoms include prolapsed hemorrhoids requiring manual reduction, pale red bleeding, accompanied by shortness of breath, fatigue, poor appetite, and abdominal distension. Mostly caused by Spleen Qi deficiency, sinking of Middle Qi, and lack of strength to hold. Treatment focuses on tonifying Qi, raising the sunken, fortifying the Spleen, and securing prolapse.

The TCM concept of "Wind" refers to a pathogenic factor characterized by "rapid movement and change," and swift onset. It also has the characteristic "where Wind prevails, there is movement," meaning it easily triggers related symptoms or diseases. "Wind" can be understood as "allergens" or "irritants" that induce acute inflammation. When stool (especially dry, hard stool) passes rapidly through the anal canal, rubbing against the mucosal surface of the hemorrhoid, it easily causes an inflammatory reaction, leading to local congestion, plasma component exudation, and even bleeding. This is similar to an invasion of "External Wind."

Clinically, these patterns often intermingle, such as a "Damp-Heat with Stasis" pattern, or a "deficiency-excess complex" pattern resulting from chronic illness.

Acupuncture Treatment

Acupuncture is one of the auxiliary therapies in TCM for treating hemorrhoids. Its core concept is to "dredge the channels, harmonize Qi and Blood, and clear and drain Damp-Heat." TCM believes the anus is traversed by the Foot Taiyang Bladder Channel and the Governor Vessel (Du Mai), and its function is closely related to the Qi dynamics of the Large Intestine, Spleen, and Stomach.

During treatment, the TCM practitioner selects acupoints on different parts of the body for stimulation based on the patient's constitution and pattern. Besides local points like Changqiang (GV1) and Huiyang (BL35), distal specific effect points are more commonly used, for example:

• Chengshan (BL57) (Calf): Belongs to the Foot Taiyang Bladder Channel. It is an empirical effective point for treating hemorrhoids, able to regulate the Qi and Blood of the anus and intestines, and relieve pain.
• Erbai (EX-UE2) (Forearm): An extra point specifically for treating hemorrhoid bleeding and prolapse.
• Kongzui (LU6) (Arm): Belongs to the Lung Channel. The Lung and Large Intestine are interior-exterior related. This point can clear and drain constrained Heat in the Large Intestine and is particularly effective for bloody stools.

Through the combination of distal and local points, acupuncture can effectively regulate the Qi and Blood circulation around the anus, relieve venous congestion, and reduce swelling, pain, and bleeding.

Besides traditional body acupuncture, the following methods are also commonly used in clinical practice:

• Moxibustion: For patients with "Qi Sinking" or "Deficiency-Cold" constitution (prolapsed hemorrhoids, shortness of breath, fatigue, aversion to cold), moxibustion can be applied to the Baihui (GV20) point on the top of the head. This point belongs to the Governor Vessel and has a strong effect of raising Yang Qi, helping to reduce prolapsed hemorrhoids. Zusanli (ST36) can also be moxibusted to fortify the Spleen and benefit Qi.
• Pricking and Bloodletting: This will be detailed in the section on external treatments.

Acupuncture treatment is notably effective in relieving pain and bleeding during acute hemorrhoid flare-ups. As an auxiliary therapy, it can enhance the effect of internal herbal medicine and regulate the overall Qi dynamic, improving pelvic circulation.

TCM External Treatments

Clinically, patients are often seen with severe pain due to significantly prolapsed or incarcerated hemorrhoids. Hemorrhoidal masses are clumps formed by the downward displacement of anal cushion tissue and the varicose venous plexuses. If subjected to prolonged pressure, inflammatory edema, or even necrosis, they cause immense suffering, affecting walking, sitting, and lying down. "In acute conditions, treat the manifestation." TCM also has many external treatments that can quickly relieve swelling and pain.

Ligation Method

TCM also historically had a "Ligation Method" similar to the modern one, using medicated threads or silk threads to ligate the base of the hemorrhoid, causing it to necrose and fall off, achieving a curative effect for a single hemorrhoid. Under the current division of medical labor in Taiwan, this traditional technique is relatively rare and is mostly performed by Western proctology surgeons; however, in the proctology departments of TCM hospitals in Mainland China, the ligation method remains a widely used routine minimally invasive treatment, often combined with internal herbal medicine, reflecting the advantages of integrated Chinese and Western medicine.

Pricking and Bloodletting

This method does not operate directly on the hemorrhoid itself. Instead, it utilizes the theories of "distal point selection" and "specific reaction points," performing treatment on other parts of the body to relieve the swelling and pain of acute flare-ups.

• Primary Point: Weizhong (BL40)
  Principle: The Weizhong point belongs to the Foot Taiyang Bladder Channel. A branch of the Bladder Channel enters deeply into the anus. TCM has the saying "For lower back and hip problems, seek Weizhong." All issues of Qi and Blood stasis located in the middle section of the body (lower back, buttocks, hips) can be treated by selecting this point. Furthermore, this area is rich in blood vessels, making it easy to release a relatively large amount of stagnant blood, with a strong heat-clearing effect.
• Secondary Points: Chize (LU5), Quze (PC3)
  Principle: These two points belong to the Lung Channel and Pericardium Channel respectively. The Lung and Large Intestine are interior-exterior related; draining Chize can clear Heat from the Large Intestine. The Heart governs the blood vessels; draining Quze can clear Heart-Heat, cool the Blood, transform stasis, and relieve pain.
• For patients with an excess pattern of "Damp-Heat and Stasis Obstruction," pricking to release a small amount of blood can be performed at points on the back's Bladder Channel, such as Dachangshu (BL25), Ciliao (BL32), or Weizhong (BL40), to rapidly clear and drain Damp-Heat from the anus and intestines, and activate Blood to transform stasis.
• Reaction Point Bloodletting:
  Principle: TCM believes that internal organ diseases manifest reaction points on the body surface (especially the back). These are typically found in the Bladder Channel region on the back or the lumbosacral area and might appear as a small red spot, papule, or tender point. After locating these reaction points, pricking them to release blood can often quickly relieve the corresponding internal organ disorder and has a remarkable effect on hemorrhoidal swelling and pain.

Understanding from a modern medical perspective:

• Pressure Reduction and Circulation Improvement: Bloodletting can instantly reduce local vascular pressure and, through traumatic stimulation, reflexively cause the body to redistribute blood, improving venous stasis in the pelvic and perianal areas, thereby achieving the goal of "reducing swelling."
• Inflammation Regulation: Studies suggest that bloodletting therapy can regulate the release of inflammatory mediators and inhibit excessive inflammatory responses, which directly corresponds to the TCM effect of "clearing Heat."
• Analgesic Effect: The stimulation from bloodletting can trigger the release of endorphins and other pain-relieving substances in the body and interrupt the vicious cycle of pain, producing a rapid analgesic effect.

This therapy is mainly suitable for acute flare-ups of excess or heat patterns (e.g., anal burning, swelling, pain, reddish-purple color). It is not suitable for those with Qi deficiency and sinking, anemia, or a weak constitution, as it may worsen the deficiency.

Bloodletting therapy can quickly relieve acute swelling and pain, serving primarily as an auxiliary "symptom-relieving" method. Its ability to produce immediate effects through distal treatment fully embodies the profundity of TCM channel theory.

External Application of Chinese Herbs

Additionally, Chinese herbs can be applied directly to the local anal area to cause the swollen hemorrhoids to contract, reduce inflammation, and relieve pain; this also addresses the symptoms. It is mainly targeted at acute flare-ups with severe pain, or patients for whom surgery is inconvenient. Specific application methods include:

• Herbal Fumigation and Wash: Decoction herbs with effects of clearing Heat and detoxifying, activating blood and reducing swelling, and astringing to stop bleeding (e.g., Rhubarb, Sophora Flavescens, Gallnut, Mirabilite) are boiled. The steam is used to fumigate the anus, and then the area is soaked in the warm liquid once the temperature is suitable. This acts directly on the affected area, quickly relieving swelling and pain.
• Ointments and Suppositories: Herbs with similar effects are made into ointments for topical application or suppositories for insertion into the anus, providing continuous local action to clear Heat, reduce swelling, relieve pain, and stop bleeding.

The above external treatments primarily address the symptoms and relieve acute manifestations. They do not address the root problems such as Damp-Heat pouring downward, Qi and Blood stasis, or sinking of Middle Qi internally. They need to be combined with internal herbal medicine, acupuncture, and other treatments to achieve long-term stability and improvement.

Acupressure

Massage the following acupoints. Press each point for 3-5 minutes, until a sore, numb, or distending sensation is felt. This helps promote Qi and Blood circulation around the anus and alleviate discomfort.

• Changqiang (GV1): Below the tip of the coccyx, at the midpoint of the line connecting the tailbone end and the anus. The Luo-Connecting point of the Governor Vessel, it acts directly on the perianal area, unblocking collaterals and relieving pain.
• Chengshan (BL57): At the top of the depression between the two bellies of the gastrocnemius muscle in the calf. An important point for treating hemorrhoids; pressing it can significantly relieve anal swelling and pain.
• Erbai (EX-UE2): On the palmar side of the forearm, 4 cun above the wrist crease, on both sides of the tendon of the radial flexor carpi muscle. Two points on one arm. An extra point specifically for hemorrhoids.
• Zusanli (ST36): 3 cun below the outer knee eye, one finger-breadth lateral to the tibia. A major strengthening point, it can fortify the Spleen and benefit Qi, improving Qi deficiency and sinking.
• Baihui (GV20): At the intersection of the midline of the head and the line connecting the tips of the two ears. The meeting point of all Yang channels. Moxibustion on this point can raise Yang Qi and assist in reducing prolapsed hemorrhoids.

Perform once in the morning and once in the evening consistently. This can serve as daily health maintenance and auxiliary treatment.

Health Preservation and Prevention

• Improve Bowel Movements:
  • Develop a regular bowel habit. Avoid prolonged squatting on the toilet and excessive straining.
  • Eat more high-fiber foods (vegetables, fruits, whole grains) and drink plenty of water to keep stools soft.
• Dietary Regulation:
  • Avoid spicy, irritating foods, barbecued, fried foods, and excessive alcohol to prevent generating and aggravating Dampness and Heat, which may pour downward to the anus and intestines.
  • Consume moderate amounts of foods that clear Heat, drain Dampness, or moisten the intestines, such as mung beans, coix seeds, black fungus, and bananas.
  • Those with Qi deficiency and sinking can moderately consume Qi-tonifying foods like Chinese yam, lotus seeds, and chicken.
• Regular Exercise: Avoid prolonged sitting; get up and move every hour. Perform Kegel exercises (lifting the anus) to strengthen pelvic muscles and promote blood return.
• Local Care: Keep the anus clean and dry. Wash with warm water after defecation. Use warm sitz baths during acute flare-ups.

Summary

TCM views hemorrhoids as a problem where local manifestations and the body's systemic condition influence each other; it is not merely a varicose vein in the anus. It is closely related to dietary habits, bowel behaviors, levels of exertion and rest, and constitutional factors. Treatment approaches include clearing and draining Damp-Heat, activating Blood and transforming stasis, or tonifying Qi and raising the sunken. Through the combination of internal herbal medicine, acupuncture, fumigation, sitz baths, and lifestyle adjustments, the aim is to restore the harmony of Qi and Blood in the anus and intestines, improve venous return, and fundamentally reduce the probability of recurrence. It can rapidly relieve acute symptoms and, for chronic patients, focuses on constitutional regulation to achieve long-term stability.